Forensic Pathology

19
CYRIL H. WECHT AND VICTOR W. WEEDN

Pathology and Forensic Pathology

"As pathology goes," remarked the pre-eminent late 19th century physician and medical
educator Sir William Osler, "so goes medicine." Pathology developed as a subspecialty
of medicine during Osier's time as "the study of disease," and the role of "pathologists"
was to perform autopsies to find out what was really wrong with a patient. Without
these raw data, medicine was largely anecdotal and speculative. Osler understood that
physicians would have to better understand disease in order to treat it and that pathologists
were the most important source of these new understandings, because they "studied
disease."
As defined by the College of American Pathologists today, pathology is that branch of
natural science concerned with the causes and nature of disease processes, together with
the anatomic and functional changes that occur in conjunction with them. Furthermore,
it is a medical specialty that may contribute to the understanding of diseases or medical
conditions by means of information obtained through various types of laboratory exam-
inations of the human body or any materials taken from the human body. In this context,
the term "disease" is used quite broadly to involve anything and everything capable of
altering the human body, from viruses and bacteria to metabolic and degenerative diseases,
to tumors and injuries of all kinds.
Pathology as a discipline tends to conjure up conceptions among medically trained
personnel that fall far short of an adequate explanation of the subspecialty of forensic
pathology, although these thoughts would adequately apply to hospital pathology. Hospi-
tal pathology and forensic pathology, although sharing many training and scientific
procedural factors, are significantly different in their approaches to death investigation.
Today, the professional practice of conventional pathology is that of the hospital
pathologist who spends his or her time practicing either "anatomic" or "clinical" pathol-
ogy. The former subspecialty involves looking at the anatomy of the cells, tissues, or organs
for evidence of disease. Thus, the anatomic pathologist examines cell ("cytology") slide
preparations, such as Pap smears and fine needle aspirations, and surgically resected speci-
mens and tissue biopsies ("histology"). He or she may also occasionally perform autopsies,

387
388 Forensic Science and Law

usually in hospitals. The primary instrument of the anatomic pathologist is the microscope,
but a pathologist can tell much about a specimen by simple visual inspection without a
microscope and, in fact, all examinations begin with this "gross pathology" inspection.
Clinical pathology, on the other hand, involves investigation of cells, tissues, and fluids
of patients through laboratory testing. Thus, clinical pathologists typically direct hospital
clinical chemistry laboratories, microbiology laboratories, hematology laboratories, blood
banks, and molecular pathology/genetic laboratories. However, these laboratory functions
are increasingly being taken over by Ph.Os in other disciplines (e.g., hematologists running
both the hematology service and the hematology diagnostic laboratory) .
Whether anatomic or clinical, hospital pathologists are charged with ascertaining
pathological findings and correlating them with the existing clinical data. In other
words, they find morphological changes to explain particular clinical signs and symptoms.
A hospital autopsy therefore seeks to verify the diagnosis made before death and evaluate
the treatment rendered pursuant to that diagnosis. The purposes of this exercise are to
increase the storehouse of medical knowledge and to provide a certain degree of quality
control. Philosophically, therefore, hospital pathologists tend to approach their examin-
ations with verification and academic discovery as their objectives. This predisposition
can lead the hospital pathologist to overlook subtleties that contraindicate clinical back-
ground, diagnosis, and treatment rendered.
Forensic pathology, which was formally recognized as a subspecialty of pathology in
19.22, is the application of pathology to medical-legal matters - specifically, the investi-
gation of violent, sudden, suspicious, unexplained, unexpected, and medically unattended
deaths for the purpose of determining the cause and manner of death. Forensic pathology
now encompasses a large body of scientific knowledge. 1 - 6 The primary tool of the forensic
pathologist is the autopsy. As hospital pathologists have stopped performing autopsies on a
routine basis in recent years, the main expertise for autopsy examinations now resides
within the forensic pathology community. Typically, forensic pathologists ply their trade
as "medical examiners" or "coroners," though they may also practice as consultants to pro-
secutors and criminal defense attorneys, or as conventional pathologists performing some
forensic autopsies as a minor part of their practice.
Whereas only patients of a hospital may be considered as falling within the purview of
the traditional hospital-based pathologist, forensic pathology serves all members of society.
The forensic pathologist must know traditional medicine and something about life in
general to adequately deal with deaths at home, at work, during recreation, in public,
and during transportation. Forensic pathologists will examine victims of heart
attacks, therapeutic error, drugs, gunshots, motor vehicular accidents, and work-related
injuries, to name but a handful of examples.
Only licensed physicians with formal training and expertise in the theory and practice
of forensic pathology should perform medical-legal autopsies. After undergraduate study
and four years of medical school, a forensic pathologist will matriculate through four years
of pathology residency and one year of forensic pathology subspecialty training, as well as
successful completion of an anatomic or combined anatomic/clinical pathology American
Board of Pathology (ABP) certification examination and a forensic pathology subspecialty
ABP certification examination. The American Council on Graduate Medical Education
(ACGME) accredits forensic pathology residency programs and the American Board of
Pathology, which is a member of the American Board of Medical Specialties, "board
certifies" forensic pathologists.
250 Forensic Science and Law

PE nl. stress
at home&
I PCPN~es I work OK to
DC

X-ray CXRnl
Findings

EKG
ST rare PVC
Findings

Laboratory Cardiac
Values enzymes nl

CP7/I0 Relief from CP 4/IO Pain free 11 Discharge I

rad L arm NTG puff NTG puff

ER EKG. NTG Admit lo

Physician puff.CE CCU for
Onlers panel, 0 1 cath

Figure 11.2 Example of medical information organization in an acute discreet event.

© Suzanne Edgett Collins

radiologist expert will be better able to answer the time and causation questions with this
type of format.
The foregoing are just two examples of the importance of the organization of the
medical information to the critical discernment of the strongest theory of the case.
Many other methods of information organization may be applicable to the kind of case
or specific question to be answered. The most user-friendly organization methods
are those that can be expanded as the information about the case grows. These summaries
of information, while clearly not evidential, become important persuasive tools in the pr-
esentation of evidence as the case progresses through discovery, mediation or arbitration,
pretrial proceedings, and trial.

A Changing Landscape: Reform Initiatives Focused on

Medical Malpractice

Increasing costs and decreasing availability of medical malpractice insurance is causing a

great deal of concern and has been the focus of on-going intense legislative efforts to
Forensic Medicine and Medical Negligence 251

Dal< Pati<nt HCP Physical Exam Radiology Pathology

Complaint Findings Finding,, Findings

4-27-96 Annual gyn exam Jones Age. weigh1.

HX,PE,normaJ
BE

5- 16-97 Annual gyn exam Smith Age. we igh1. HX.

PE. normal BE

5-3-98 Annual gyn exam Smith Age, weight, HX,

PE. normal BE

4-15-99 Annual gyn exam Jones Age, weigh1. HX.

PE. abnonnaJ L
BE

5-2-99 Johnson Ultra~ound report

Mammography
report

6-1-99 Wilson Biopsy L breast

speci men gross,
micro

5- 15-00 Annual gyn exam Smilh Age. weight. HX.

PE.normal BE

3-28-01 Tender L breast Jones A ge, weight HX.

and L axilla PE, abnormaJ L
BE

4-30-01 Johnson Ultrasound report

Mammography

Figure 11.3 Example of m edical information organization in delayed diagnosis. (1) Suzanne
Edgett Collins

deal with the problem in many of the States. Medical errors do in fact occur and the stigma
associated with such errors may drive reporting of these errors underground. The legal
system is a rather ineffective means of providing compensation, fostering great costs
with relatively small returns, and few injured patients are actually fully compensated
through a medical malpractice lawsuit. This results in cost shifting to both public and
private insurance, Medicare, Medicaid, and to compensation programs such as sick
leave, disability, and other programs.
The Council of State Governments (2003) identifies three prongs of the medical
malpractice insurance crisis: ( 1) There are in fact medial care providers whose conduct
results in medical negligence claims; (2) legal resolution of these claims involves a great
deal of time, effort and money; and (3) the medical malpractice insurance industry is
influenced by economic forces outside those of the physician's claims experience.
 8:24~

< a www.fameonline.org C [J
E 12.1 collect swabs of oral, vaginal, and rectal cavities.
E 12.2 collect pubic hair combings or tape lifts.
·ollect fingernail scrapings or clippings.
,llect pubic and head hair exemplars.
16 Qf 2 6 lentify and preserve foreign hairs, fibers, and biological stains.

Standard E13 Injuries: General

Documentation of injuries may be necessary to determine the nature of the object used to
inflict the wounds, how the injuries were incurred, and whether the injuries were a result
of an accident, homicide, or suicide. Written, diagrammatic, and photographic
documentation of the injuries may be used in court. Observalions and findings are
documenled 10 support or refine in1erpre1a1ions, 10 provide evidence for court, and to serve
as a record.

The forensic pathologist shall:

E13.I describe injuries.

El3.2 describe injury by type.
El3.3 describe injury by location.
El3.4 describe injury by size.
E 13.5 describe injury by shape.
E 13.6 describe injury by pattern.

15

Standard E14 Photographic Documentation

Photographic documentation complemenls written documentation of wounds and creates a
permanent record of forensic autopsy details. Photographic docurnentalion of major
wounds and injury shall include a reference scale in at least one photograph of the wound
or injury to allow for I: I reproduction.

The forensic pathologist or representative shall:

E 14. 1 photograph injuries unobs1ruc1ed by blood, foreign matter, or clothing.

E 14.2 pholograph major injuries wilh a scale.

Standard EIS Firearm Injuries

Documenlation of firearm wounds as listed below should include detail s ufficient to
provide meaningful information to users of the forensic autopsy report, and 10 permit
another forensic pathologisl 10 draw independenl conclusions based on the documenlation.

The forensic pathologist shall:

E IS.I describe injuries.

EIS.2 measure wound size.
EIS.3 locate culaneous wounds of the head, neck, torso, or lower extremities by
measuring from either the top of head or sole of foot.
EIS.4 locate cutaneous wounds of the head, neck, torso, or lower extremities by
measuring from either the anterior or posterior midline.
EIS.5 locate cutaneous wounds of the upper extremities by measuring from anatomic
landmarks.
E IS.6 descriplively locate cu1aneous wounds in an anatomic region.
E 15. 7 describe presence or absence of soot and stippling.
E 15.8 describe presence of abrasion ring, searing, muzzle imprint, lacerations.

< > ro
 8:25~

< a www.fameonline.org C
G29. l source of sample.
r..-,n,, •vpe of screen.
·st results.
24 Qf 26 ,ethodofanalysis.

Standard G30 Evidence Processing

C ustodial maintenance and chain o f custody are legally required elements for documenting
the handling of evidence.

The forensic pathologist or representative shall:

G30. I collect, package, label, and preserve all evidentiary items.

G30.2 document chain of custody of all evidentiary items.

23

Section H: Documentation and Reports

The purpose of this section includes standards for the content and format of the
postmortem record.

Standard H31 Postmortem Examination Report

Postmortem inspection and forensic autopsy reports must be readable, descriptive of
findings, and include interpretations and opinions to make them informative. The report
typically includes two separate parts of the forensic pathologist 's work product, {I) the
objective forensic autopsy with its findings including toxicological tests, special tests,
microscopic examination, etc., and (2) the interpretations of the forensic patho logist.

The forensic pathologist shall:

H31.l prepare a written narrative report for each postmortem examination.

H31.2 include the date, place, and time of examination.
H31.3 include the name of deceased, if known.
H3 1.4 include the case number.
H31.5 include observations of the external examination, and when performed, the
internal examination.
H31.6 include a separate section on injuries.
H31.7 include a description of internal and external injuries.
H31.8 include descriptions of findings in sufficient detail to support diagnoses,
opinions, and conclusions.
H 3 1.9 include a list of the diagnoses and interpretations in forensic autopsy reports.
H 3 1.IO include cause of death.
H31.ll include the name and title of each forensic pathologist.
H31. 12 sign and date each postmortem examination report.

< > ro
 9:01 ~

< a 10ns.law.umaryland.edu C

experc," send a resounding proclamacion 10 follow one's calling. Pimburgh lnscirnte of L,

His calling is forensic pachology, 1he mos1 incegraced medical The emphasis Wed·
field 1ha1 incerfaces wich law, explains Wech1. During his residen- denc. He recognized fror
cy a11he Vecerans Adminiscracion Hospical in Piccsburgh, Pa., he points and the weak poir
was allowed co anend che Universiry of Piccsburgh School of Law. throughout 1he councry
In 1959, wich one year of law school remaining, he was senc co rhe 10 understand the need f
U.S. Air Force Hospical, Maxwell Air Force Base, Moncgomery, councry, there are sci II n<
Ala., as associace pachologisc. Under 1he Berry Program, his com- accencuace che legal aspe
pulsory milirnry service allowed him co gain credi1 for rwo years of The same is noc cru,
medical school plus a residency. Maryland School of La"
Balcimore held che answer for his rwo remaining years of edu- esc and direccion has spu
cacion : he finished his medical craining as a research fellow in program . Similarly, ic is
forensic pachology and associate pathologisc, Office of 1he Chief and develop a program a
Medical Examiner, while anending evening classes a1 che School of and law. The program, ,
Law. Thai wasn'1 all he accomplished. While working evenings as formally approved ac che
a pa1hologis1 ac Norch Charles General Hospical, he found 1ime co and a January 200 I enrc
cour1 and marry his girlfriend from 1he Air Force base, a Norway lnscicuce of Forensic Sci<
nacive named Sigrid. 1962 was a produccive year. endeavors: a cercificate p
Pinsburgh was his home and upon his recurn, his career cook mascer's in forensic scier
off. He simulcaneously held
posicions as accing chief and
pachologisc in various hospitals
while ceachi ng as a clinical
inscruccor in medicine and
pachology, a leccurer in legal
medicine and a research pro-
fessor of law for various univer-
sicies. Though mos1 of his
experience is in forensic
parhology, his incerescs and
legal craining have led him
down 1he path coward bioechi-
cal quescions of human
research and experimencacion,
medic.11 malpraccice and med-
ical/legal consulcacion.
Wechc's inrerescs, pas-
sions and expercise presenced
ye1 anocher avenue for explo-
ration . Wecht has auchoced
more than 420 professional
publicacions, is on 1he editori-
al board of more than 20
nacional and internacional
medical-legal and forensic sci-
encific publications and edicor
J of 35 books. He has organized

< > ro
 9:03
◄ Google

i digitalcommons.law.umaryland.edu
vcnialcasc:s.
The only child of immigranu (his father from Lirhuania and
morhn from Russia), W«hr embodies the m1ndard work c1hic of
his ~ntnirK>n. In col~. as is typical with the resc of his life, he
was wry acciw and involved... I was a Big Man on Campus,
involved in scudcnt government, my fr.ucrnicy; everyone wumcd
I wu pre-law." As a sophomore, wirh assumptions 1ha1 he was a
law student, M' wrocc ro rhc Medical Association 10 inquire about
a joint mtdicallkgal dqrtt.
In rcsponK, he was invited to rhc first AMA/ASA Biannual
Conference in New York Ciry. "h was all over my head," Wech1
cxdainu, bur a conference speaker mcc with him for 15 co 20
minutes and W«hr decided "rhcn and rhcrc 1hat I would go ro
law school."
The MP'iw fttdback he cncoumcrcd: "You can't scrvr two
maners," "Thott art rwo sq,ar:nc disciplines,.. "You'll ~ r be
conJOOtd a docror or a lawyer," ofcourse did not dc-,er him. Years
later his books:, wirh r ~ fouling W«ht as "a leading forensic

C'llpen," )(lld a rC'sounding procl2m21ion 10 follow onc-'s calling. Pimburgh lns1i1111c- of Legal Medicine-.
Hi) calling is forensic pa1hology, thc mo)C inc~r.utd m«tica.l The- emphasis Wcch1 has pl.iced on lc-ga.l mc-dicinc- ,s no acci-
ficld 1ha1 imcrfacc-s wi1h l;iw, cxplains WC'ch1. During his r~tdc-n- den1. He- rc-cogniud from his own c-duca1ion wt-icre the- mong
cy a, ,he- Vc-1cr.1ns Administradon l-lospical in Pimburgh, Pa.. he poincs and 1hc- WC'ak poinu lie-. "For centuries, mcdtcal schools
w,15 allowC'd 10 :mend the Univcrsicy of Pimbu1·gh School of Law. throughout the- coumry have- included legal course-work for doccors
In 19~9. with one ynr oflaw school rem.1ining, he w,u scn1 10 the 10 undc-rstand ,he n«d for legal expcrcisc. Mos1 regrc-uably. in 1his
U.S. Air force- Hospical, Mnwell Air Force Hase, Montgomery, counrry. the-re- arc- s1ill no courses offered me-dial srudenn 1ha1
Ala.. 2s 2ssoci:'ltC' pa1hologi,1. Under the- llcrry Prognm. his com- accc-nwace 1hc-lc-g.il 2spcc1s of mc-dicinc-."
pulsory mil112ry S(~•ice allowed him 10 gain crc-di1 for two ~;us of The- s.,mc- is not true for lc-g11l cducarion. Ar 1hc- Univc-rmy or
medical school plus 2 rc-sidency. Maryland School of Law. Cua11 Karen H. Ro,hcnbtrg's own inu:r•
82himorc- held 1hc- answtr for his rwo rc-nuining ~ars of cdu- csc .rnd direction has spurrc-d 1he School's Law and Hc-ahh Ca~
C3tion: he- fin ished his mc-dical craining as a rc-scuc h fdlow in program. Similarly.iris anorher ofWc-cht's callings 10 fill .1 nc-cd
forensic p:11hology and associa1c- pathologist, Offi« of 1hc- Chic-f and dcvc-lop a program a, Duquc-snc- Universiry in forensic K ic-ncc-
Mc-dic:ll Examiner, while- mending c-vc-ning classes at the- School of and law. ~ program, which was two yc-ars in 1hc- making, will bt
Law. Thai wasn'1 211 he- accompfo;hc-d. While- working c-vc-nings as formally approvcd a, rhe end or Octobc-r with a campus kick off
11 pa1hologi1,t ac Nonh Charles Gc-nc-ral Hospn.11I. he- found rime- 10 and a J.m uary 2001 enrollmc-nt dare. The Cyril H. W«h1
coun and marry his girlfriend fcom the- Air Force- basc, a Norw.1y lnS1i1u1e of Forc-nsic Sc,c-ncc- .md Law offers rwo major arc-as of
native n2mc-d Sigrid. 1962 was a produc1ive yc-ar. endeavors: .i cc-nif1u1e program 1ha1 is part of 1hc- law school and 2
Piusburgh was his home 2nd upon his ~turn, his career took masm·s in forensic scic-ncc-. offering 12 10 IS credit hours from
off. He- simuhanrously hdd the- bw school, and sp<cial.
posicions as acting chic-( and nc-wly cteacc-d courscs in ltg;il
pathologist in v;arious hospitals mc-dicine and forc-nsic scic-ncc-.
while cc-aching as A clinical Various gr.adua1c- school
insm1c1or in medicine and irwolvc-ment includes che
p.ithology, a l«iurc-r in le-gal nursing scAool. school of
medicine and a research pro- pharm11cology and coxicology.
fo10r oflaw for various univer- among 01hc-rs.
sirics. Though mos1or his Ja.me:s Zimmc-rly, MD,
c-,:pcric-m:e is in forc-nsic '69 :tnd De-an Ro1henbtrg.
pathology, his incc-rcsn and both of whom arc- held in
legal mining have kd him highesr c-sreem by Wc-cht.
down 1hc- pa1h 1oward bioc1hi- h:ave been invicc-d to bt mc-m-
c:al questions of human bcrs of rhe Advisory Bo:ird for
me-arch and npcrimc-nmion, Duquc-sne Univc-rsiry\ new
rnc-dic:1I malpr.1t.1ict and med• lnscirnte or forc-nsic Sc1c-nce
ic111/lcg.al comul1.:1 1ion. and Law.
Wedu's 11uereus, pas• The- f1ui1doc-sn'1 fall fur
sions Jnd ex~ni~ prc-sencc-d from the- lrC'C' whc-rt We-chi\
yc-1another avc-nue for explo• family is concc-rncd. He-, his
rJ1ion. Wech1 has au1hou:d wire and ddesc son h:avc- a
more- 1ha11 420 professional family firm, the Wcch, Ltw
publicacions, u on chc- c-ditori• f irm. His second ion is a
al bo:u d of more- 1ha n 20 nc-urosurgcon and 1hird son.
national and iniernarional Bcnjamin, ,1 wruer who has
mcdical•lc-gal 2nd forensic sci- work«t wich W«h1 on hi,
entific public:acions and edicor books, Cmm of!Rat/, ,rnd
of 35 books. He- has organized Graw ~rrrtJ. Ingrid. his
:ind conducted pos1gradua1c- daughcer, is an O8/GYN.
medical-legal scminan in Wc-chc and his w,fc- enjoy
more- 1han 50 coumric-s in his sc-ven grindchildrc-n, as the-
cap.:icicy as dir«1or of 1hc- e-mire- family re-sides in
Pi1csburgh.

H JD MACAZJN[ ►AlL !OOO

< > rn
 9:03
◄ Google

i digitalcommons.law.umaryland.edu
vcnialcasc:s.
The only child of immigranu (his father from Lirhuania and
morhn from Russia), W«hr embodies the m1ndard work c1hic of
his ~ntnirK>n. In col~. as is typical with the resc of his life, he
was wry acciw and involved... I was a Big Man on Campus,
involved in scudcnt government, my fr.ucrnicy; everyone wumcd
I wu pre-law." As a sophomore, wirh assumptions 1ha1 he was a
law student, M' wrocc ro rhc Medical Association 10 inquire about
a joint mtdicallkgal dqrtt.
In rcsponK, he was invited to rhc first AMA/ASA Biannual
Conference in New York Ciry. "h was all over my head," Wech1
cxdainu, bur a conference speaker mcc with him for 15 co 20
minutes and W«hr decided "rhcn and rhcrc 1hat I would go ro
law school."
The MP'iw fttdback he cncoumcrcd: "You can't scrvr two
maners," "Thott art rwo sq,ar:nc disciplines,.. "You'll ~ r be
conJOOtd a docror or a lawyer," ofcourse did not de,c-r him. Years
later his books:, wirh r ~ fouling W«ht as "a leading forensic

C'llpen," )(lld a r('sounding procl2m21ion 10 follow one's calling. Pimburgh lns1i1111e of Legal Medicine.
Hi) calling is ror('nsic pa1hology, th(' mo)c inc~r.utd m«tica.l The- emphasis Wech1 has pl.iced on legal medicine ,s no acci-
fidd 1h,u imerfaces wi1h l;iw, explains Wech1. During his r~tden- den1. He rrcogniud from his own educa1ion where 1hc- mong
cy a, ,he Ve1erans Administradon l-lospical in Pimburgh, Pa.. he points and 1he WC'ak poinu lie. "For centuries, medtcal schools
W35 allowC'd 10 :mend the University or Pimbu1·gh School or Law. throughout the- coumry have included legal coursework for doc1ors
In 19~9. with one year oflaw school rem.1ining, he w,u scn1 10 the 10 undcrsrand ,he n«d for legal expcnisc. Mos1 regreuably. in 1his
U.S. Air force Hospical. Mnwell Air Force Hase, Montgomery, counrry. there are s1ill no courses offered medical srudenn 1ha1
Ala.. 2s 2ssoci:ue pa1hologi,1. Under the- llcrry Prognm. his com- accencuace 1he leg.ii 2spcc1s of mc-dicinc-."
pulsory mil11:1ry sc~•ice allowed him 10 gain crc-cfil for two ~;us of The s.,me is not irue for legal educarion. Ar 1he Univc-rmy of
medical school plus 2 rc-sidency. Maryland School of Law. Cua11 Karen H. Ro,henberg's own i111er•
Bahimore hdd 1hc- answtr for his rwo renuining ~ars of C'Ou- esc .rnd dir«rion has spurred 1he School's Law and Health Ca~
e31ion: he fin ished his mc-dical craining as a rc-scuc h fdlow in program. Similarly.iris anorher ofWecht's callings 10 fill a need
forensic p:11hology and associa1e pathologist, Offi« of 1hc- Chic-f and develop a program a, Duquesne Universiry in forensic K ience
Medic:ll Examiner, while mending evening classes at the School of and law. The prognm, which was two years in 1he making. will be
Law. Thai wasn'1 211 he accompfo;hed. While working evc-nings as formally approv~ 21 rhe ('nd of October with a campus kick off
11 pa1hologi1,t ac Nonh Charles GenC'ral Hospnal. he found rime 10 and a J.muary 2001 enrollment dare. The Cyril H. Wech1
coun and marry his girlfriend fcom the- Air Force- base, a Norway lnS1i1U1e of Forensic Science .md Law offers rwo major areas or
native n2mc-d Sigrid. 1962 was a produc1ive year. endeavors: a cenificace program 1ha1 is part of 1he law school and 2
Piusburgh was his home 2nd upon his ~turn, his career took masm's in forensic science. offering 12 10 15 credit hours from
off. He simuhanrously hdd 1he bw school, and special.
posicions as acting chief and newly cteaced courses in ltgal
pathologist in v;arious hospitals medicine and forensic science.
while cc-aching as a clinical Various gradu21c- school
insm1ctor in medicine and involvement includes the
p.ithology, a l«iurer in le-gal nursing scllool. school of
medicine and a research pro- pharmacology and 1oxicology.
fo10r of12w for various univer- among 01hers.
sirics. Though mos1of his James Zimmerly, MD,
c-,:peric-m:e is in forensic '69 :tnd De-an Ro1henberg.
pathology, his incc-rcsn and both of whom are held in
legal mining have kd him higheSI c-ueem l,y Wecht.
down 1he pa1h 1oward l,ioc1hi- have b('en inviced to be mem-
c:al questions of human bc:-rs of rhe Advisory Bo:ird for
me-arch and c-xpcrimc-nr:uion, Duquesne Universiry\ new
rnedic:1I malpr.u.1ice :ind med• lnscirnte of forc-nsic Science
ic.11/lcg.al comul1.:1 1ion. and Law.
Wcdu's 11uereus, pas• The f1ui1doc-sn'1 fall fur
sions Jnd expeni)C presenrc-d from the 1ree where We-chi\
yC'f another avenue- for explo• family is concerned. He, his
rJ1ion. Wech1 has .au1ho1ed wi(e and ddesc son h2ve a
more 1h.111 420 proressional family firm, the W«ht Ltw
publicacions, u on che c-ditori• f irm. His second ion is a
al l>o:u d of more rha n 20 neurosurgeon and 1hird son.
national and ini('tnarional Benjamin, ,1 wruer who has
mcdical•lcgal 2nd forensic sci- work«t wich W«h1 on hi,
entific publicacions and edicor books, Cmm of!Rat/, ,rnd
of 35 books. He has organized Graw ~rrrtJ. Ingrid. his
:ind conducted pos1gradua1e daughcer, is an O8/GYN.
medical-legal scminan in Wech1 and his w,fe enjoy
more 1han 50 countries in his seven grandchildr('n, as the
cap.:icicy .as dir«1or of 1he eniire family resides in
Pi1uburgh.

H JD MACAZJN[ ►AlL !OOO

< > rn
 9:21 ~

< a documents.cap.org C [J

{AduH)
Postmortem Flow Chart
Obtain Death Forms;
Make appropriate phone calls;
Identify who pronounced death, date, time

I
Autopsy?

No Autopsy Forensic Autopsy Hospital Autopsy

! !
Requested?
_ Yes, refused
No
l
Identification tags and labels
Any hazard labels
Consent forms (note restrictions)
Donation forms
Identification tags and labels
Any hazard labels
Leave medical devices in place Leave medical devices in place
Position hands correctly Position hands correctly
Locate personal effects Locate personal effects and
Insure chain of custody give to family
Locate chart Locate chart
Secure any lab specimens Transport to morgue
Transport to morgue Refrigerate
Refrigerate after medicolegal clearance Place body face-up
Place body face-up

< > ro
10:23.,

(3) deaths occurring as a result of

violence or trauma, whether apparently
homicidal, suicidal or accidental
(including, but not limited to, those due
to mechanical, thermal, chemical,
electrical or radiational injury, drowning,
cave-ins and subsidences);

(4) any death in which trauma, chemical

injury, drug overdose or reaction to
drugs or medication or medical
treatment was a primary or secondary,
direct or indirect, contributory,
aggravating or precipitating cause of
death;

(5) operative and peri-operative deaths

in which the death is not readily
explainable on the basis of prior disease;

(6) any death wherein the body is

unidentified or unclaimed;

(7) deaths known or suspected as due to

contagious disease and constituting a
public hazard;

(8) deaths occurring in prison or a penal

institution or while in the custody of the
police;

(9) deaths of persons whose bodies are

to be cremated, buried at sea or